World journal of emergency medicine最新文献

Background: In this study, we aimed to evaluate the impact of mechanical ventilator (MV) utilizaton during cardiopulmonary resuscitation (CPR) on out-of-hospital cardiac arrest (OHCA) patient clinical outcomes in the emergency department.

Methods: This single-centered, retrospective, case-control study analyzed electronic medical records. Patients aged >18 years with non-traumatic OHCA who were treated at an emergency medical center between January 2019 and December 2023 were included. These patients were accessed according to the ventilatory method used: MV ventilation (volume control, tidal volume 6-8 mL/kg, frequency 10 beat per minute, inspiratory time 1 s) and manual resuscitator bag valve (BV) ventilation. The primary outcome was the return of spontaneous circulation (ROSC). After 1:1 propensity score matching, the clinical outcomes were analyzed.

Results: A total of 649 patients were enrolled in this study. Before matching, the clinical outcomes and pneumothorax incidence did not differ between the MV and BV groups. After 1:1 matching between the two groups using propensity scores, 522 patients (261 MV and 261 BV) were analyzed. Propensity score matching yielded an adequate balance (standardized mean difference <0.10) for all covariates. The estimated odds ratio (OR) for ROSC was 1.23 (95% confidence interval [CI]: 0.85-1.77; P=0.267), for survival at hospital admission was 1.02 (95%CI: 0.68-1.53; P=0.918), for survival at hospital discharge was 2.31 (95%CI: 1.10-5.20; P=0.033), and for good neurologic outcome was 2.56 (95%CI: 0.84-9.43; P= 0.116).

Conclusion: In patients with OHCA admitted to the emergency department, MV ventilation during CPR showed clinical outcomes similar to those of BV ventilation in most measures. However, survival at hospital discharge was significantly higher in the MV group, suggesting potential benefits of MV use in selected patients.

Background: The lack of a stable, easy-to-operate animal model for severe trauma has hindered the research progress. The aim of this study is to develop a mouse model that replicates the pathophysiological conditions of severe trauma, providing a reliable research tool.

Methods: Male C57BL/6J mice (aged 8-10 weeks and weighting approximately 20 g) were used to establish the severe trauma model. Under anesthesia, a midshaft femoral fracture was created and packed with sterile cotton. A midline incision was made from the inguinal region to the sternum, exposing the abdominal organs for 30 min. The right femoral artery was cannulated to induce controlled blood loss at 30%, 35%, 40%, and 50% of the total blood volume. Survival rates were monitored for 24 h post-induction. In the mice that experienced 30% blood loss, the mean arterial pressure, body temperature, blood gas parameters, peripheral blood inflammatory markers, and major organ pathological changes were assessed.

Results: Mice with femoral fractures, soft tissue injuries, abdominal organ exposure, and 30% blood loss exhibited stable survival rates. Increased blood loss significantly reduced survival rates. Mean arterial pressure decreased initially, recovering within 0-15 min and returning to baseline by 50 min. Similarly, the body temperature decreased initially and gradually recovered to baseline within 50 min. Levels of peripheral blood inflammatory markers remained elevated for 12 h post-injury. Distant organs, including intestines, lungs, liver, spleen and kidneys, displayed varying degrees of injury.

Conclusion: The established mouse model replicates the pathophysiological responses to severe trauma, indicating stability and reproducibility, which could be an useful tool for further trauma research.

Background: Electrolyte imbalance is common following traumatic brain injury (TBI) and can significantly impact patient outcomes. We aimed to explore the occurrence, patterns, and consequences of electrolyte imbalance in adult patients with TBI.

Methods: A retrospective study was conducted from 2016 to 2021 at a level 1 trauma center among hospitalized TBI patients. On admission, the levels of serum electrolytes, including sodium, potassium, calcium, magnesium, and phosphate, were analyzed. Demographics, injury characteristics, and interventions were assessed. The primary outcome was the in-hospital mortality. Multivariate logistic regression analysis was performed to identify independent predictors of mortality in TBI patients.

Results: A total of 922 TBI patients were included in the analysis, of whom 902 (98%) had electrolyte imbalance. The mean age of patients with electrolyte imbalance was 32.0±15.0 years. Most patients were males (94%). The most common electrolyte abnormalities were hypocalcemia, hypophosphatemia, and hypokalemia. The overall in-hospital mortality rate was 22% in the entire cohort. In multivariate logistic analysis, the predictors of mortality included age (odds ratio [OR]=1.029, 95% confidence intervals [CI]: 1.013-1.046, P<0.001), low GCS (OR=0.883, 95%CI: 0.816-0.956, P=0.002), high Injury Severity Score (ISS) scale (OR=1.051, 95%CI: 1.026-1.078, P<0.001), hypernatremia (OR=2.175, 95%CI: 1.196-3.955, P=0.011), hyperkalemia (OR=4.862, 95%CI: 1.222-19.347; P=0.025), low serum bicarbonate levels (OR=0.926, 95%CI: 0.868-0.988, P=0.020), high serum lactate levels (OR=1.128, 95%CI: 1.022-1.244, P=0.017), high glucose levels (OR=1.072, 95%CI: 1.014-1.133, P=0.015), a longer activated partial thromboplastin time (OR=1.054, 95%CI: 1.024-1.084, P<0.001) and higer international normalized ratio (INR) (OR=3.825, 95%CI: 1.592-9.188, P=0.003).

Conclusion: Electrolyte imbalance is common in TBI patients, with the significant prevalence of hypocalcemia, hypophosphatemia, and hypokalemia. However, hypernatremia and hyperkalemia were associated with the risk of mortality, emphasizing the need for further research to comprehend electrolyte dynamics in TBI patients.